Treatment of Lyme borreliosis

Abstract

Borrelia burgdorferi sensu lato is the causative agent of Lyme borreliosis in humans. This inflammatory disease can affect the skin, the peripheral and central nervous system, the musculoskeletal and cardiovascular system and rarely the eyes. Early stages are directly associated with viable bacteria at the site of inflammation. The pathogen-host interaction is complex and has been elucidated only in part. B. burgdorferi is highly susceptible to antibiotic treatment and the majority of patients profit from this treatment. Some patients develop chronic persistent disease despite repeated antibiotics. Whether this is a sequel of pathogen persistence or a status of chronic auto-inflammation, auto-immunity or a form of fibromyalgia is highly debated. Since vaccination is not available, prevention of a tick bite or chemoprophylaxis is important. If the infection is manifest, then treatment strategies should target not only the pathogen by using antibiotics but also the chronic inflammation by using anti-inflammatory drugs.

Figure 1

In vitro antimicrobial susceptibility of Borrelia burgdorferi sensu strictu. Reduction of viable spirochetes in the presence of different concentrations of antibiotics (ceftriaxone, doxycycline). Cotrimoxazole, which is considered ineffective, is used as a control. Only in high doses does cotrimoxazole show a reduction in the amount of spirochaetes after a few days. Tests were performed on microtitre plates by broth dilution; spirochete count determined by dark-field microscopy.